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My names are Leah Kavere Amadi, a registered Nurse/ Midwife. I m a Kenyan and my presentation will be in English and on power point. My work as a humanitarian worker as a reproductive health provider for about 12 years in different Countries for different international organizations/UN and for Kenya Government for fifteen years. In 1994-1995, worked in Tanzania during the Rwandan genocide, Kakuma refugees’ camp in Northern Kenya which hosted mostly Southern Sudanese for three and half years, worked in South Sudan during the war and after the war (independence) for three years, worked in Liberia during the war and after Ellen Johnson became the president in 2006 for one and half years, worked in West Darfur and South Darfur for three and half year. My presentation will be on achievements/ challenges/lessons learned during my work as a nurse midwife trainer/Mentorship of midwives/ and hands on- during on Job training/Setting standards and procedures which are not always in place during crisis in order to promote maternal and child health services - aimed at reduction in morbidity/ mortality rate, through provision of appropriate and comprehensive health services to women and their new born babies before, during and after delivery. Due to war and instabilities in these countries, the trainings improved the knowledge and skills of the midwives on identification of mothers at risk / provide emergency obstetric care / promptly referral, promotion of quality care, maintaining Universal precautions, data collection and record keeping and provision of health education on RH activities in there communities. I enjoy working as a midwife, supporting the staff and working at the ante natal/labour and delivery/ provide post natal care**. My happiness is after assisting a mother during delivery and at the end of it – have alive and well mother and baby.** Challenges encountered in Maternal and child health services: e.g. lack of basic maternal health services( no structures or services at all),lack/ or inadequate number of skilled medical personnel, lack or in adequate supply of emergency drugs, equipments and medical materials, ineffective referral system, lack of community participation, lack of IEC( information, Education and communication) Materials for health promotion, no data collection. gesegbona@aol.com ||  || Training Midwives in 4 days in Maternal Critical Care in Africa: Why, How & What?
 * [[image:IMG_0013.JPG width="240" height="360"]]Gloria Esegbona

BACKGROUND

Many mothers (& babies) in Africa suffer from conditions which are preventable. The strong survive. Others die because of lack of anticipation, recognition and treatment. So they are allowed to get too sick, and there isn’t a system to deliver the care that they need because of lack of resources. More needs to be done to detect illness early in mothers before it gets critical. But a healthworker shortage in Africa hinders progress.

PURPOSE

I will describe how a critical care unit (CCU) was set up within just 4 days in November 2013 in Blantyre, Malawi and why it was critical that midwives spearheaded this innovation.

METHODOLOGY

Training sessions were conducted over 3 months in Blantyre, Malawi for midwives and clinical officers. Pre and post-assessment of theoretical knowledge and skills was performed.

FINDINGS

Shortage of staff meant that holding workshops that took them away from the clinical area was untenable. Instead midwives learnt to identify sick women in-house and transfer them to the critical unit all within a day. Then they were guided in bite sized bedside workshops how to care for them, and design their own documentation and observation charts establishing a novel take on the early warning score called ChEWA (Chatinkha Early Warning Alarm). This was layered with pathophysiological and guideline training to enable staff to appreciate the background to the conditions there were dealing and how simple interventions could make the difference between life and death.

Findings from pre-assessment revealed that most of the participants lacked basic competencies to provide critical care to women. The post-assessment showed an increase in knowledge and skills and a desire for continued advanced CPD in numerous areas in the curriculum to enhance acceptance, motivation and retention.

To date over 500 extremely sick women have been discharged healthily from the CCU – the commonest reasons for admission are severe sepsis with organ dysfunction, severe pre-eclampsia/eclampsia and haemorrhage of >2 litres.

CONCLUSIONS

The critical part of the project was simplifying complex pathology and management and midwives stepping up to extend their scope of practice – this will help with motivation and retention and delivery. But there are ongoing challenges including covering shifts in the unit because of not enough midwives in other service areas printing charts, and needing equipment. And importantly political buy-in recognising the importance of midwives. ||

**NB: Currently working in South Sudan for UNFPA, Juba and stationed at Wau SMoH, Western Bahr El Ghazal State as IUNV Midwife.**